Ways to improve for next year

[FattySlug]

Hi guys,

I unfortunately did not match this year and just want to get your insights on all the things I can do to improve my chances.

AMG
Step 1: 227 Step 2 CK: 240s Step 2 CS passed at second attempt (I was sick the first time) step 3: Cannot remember the score now. Maybe 220s-230s.
Chief resident.
No in-house fellowship. From a community program with connection to a highly ranked university programs.
4 GI publications (2 as first author and 1 as second). 1 published in hepatology.
1 Abstract that won an award at ACG though I did not present it myself but was listed as first author, 1 Case report in ACG
2 posters (I presented 1 at DDW).
4 LORs (strong PD LOR since I am chief, 2 GI LOR from nationally known faculty who works at the university, the last GI letter was also from a well published faculty at my home institution)

I applied first to 40 programs and added about 80 more 2 weeks after the application opens. Overall I got only 5 interviews. I talked to my PD and some GI attendings afterwards and they think it was because of my CS attempt that got me screened out (though another recent poster has 11 IV with a failed CS so it could just be my app) and hurt my final ranking. My PD has personal connection with one of the GI PD nearby (where I did interview and have very good feedback afterwards) and is trying to find out exactly why I did not match there so I am waiting to hear from that. My PD said I should have proactively explained about the CS during interview trails and she could have put in her letter to support it.

My affiliated university program offered a 1 year GIM fellowship that is supposed to give additional training to internist on sub-specialty topics (I can do away rotation on GI to build some connection), med ed, Ultrasound and time for clinical research and QI.

I can't change the CS and my mediocre board score but here are the things I am planning to do differently next cycle:
1) Apply broadly from the very beginning.
2) Address the CS fail in LOR and interview.
3) Be more aggressive in having faculty calling for me.
4) Take the above GIM fellowship to stay in academic and wrap up my outstanding research projects. Also I think it looks better than just doing hospitalist and if I do end up never match and want to to academic hospitalist it will help.

However, from my reading on here seems like the best chance is to do hepatology year. The programs I found are below, if you know of any other place especially on the West Coast please let me know. Thank you.

Temple
Rutgers
UMissouri
Virginia Mason
Dartmouth
UChicago
Einstein (Philly)

---

Members don't see this ad.

 

[ShiShiMD]

Hi guys,

I unfortunately did not match this year and just want to get your insights on all the things I can do to improve my chances.

AMG
Step 1: 227 Step 2 CK: 240s Step 2 CS passed at second attempt (I was sick the first time) step 3: Cannot remember the score now. Maybe 220s-230s.
Chief resident.
No in-house fellowship. From a community program with connection to a highly ranked university programs.
4 GI publications (2 as first author and 1 as second). 1 published in hepatology.
1 Abstract that won an award at ACG though I did not present it myself but was listed as first author, 1 Case report in ACG
2 posters (I presented 1 at DDW).
4 LORs (strong PD LOR since I am chief, 2 GI LOR from nationally known faculty who works at the university, the last GI letter was also from a well published faculty at my home institution)

I applied first to 40 programs and added about 80 more 2 weeks after the application opens. Overall I got only 5 interviews. I talked to my PD and some GI attendings afterwards and they think it was because of my CS attempt that got me screened out (though another recent poster has 11 IV with a failed CS so it could just be my app) and hurt my final ranking. My PD has personal connection with one of the GI PD nearby (where I did interview and have very good feedback afterwards) and is trying to find out exactly why I did not match there so I am waiting to hear from that. My PD said I should have proactively explained about the CS during interview trails and she could have put in her letter to support it.

My affiliated university program offered a 1 year GIM fellowship that is supposed to give additional training to internist on sub-specialty topics (I can do away rotation on GI to build some connection), med ed, Ultrasound and time for clinical research and QI.

I can't change the CS and my mediocre board score but here are the things I am planning to do differently next cycle:
1) Apply broadly from the very beginning.
2) Address the CS fail in LOR and interview.
3) Be more aggressive in having faculty calling for me.
4) Take the above GIM fellowship to stay in academic and wrap up my outstanding research projects. Also I think it looks better than just doing hospitalist and if I do end up never match and want to to academic hospitalist it will help.

However, from my reading on here seems like the best chance is to do hepatology year. The programs I found are below, if you know of any other place especially on the West Coast please let me know. Thank you.

Temple
Rutgers
UMissouri
Virginia Mason
Dartmouth
UChicago
Einstein (Philly)

sorry to hear that.

your plan is excellent. Do the Hep fellowship. Keep on publishing or work as a Hospitalist on a GI group.

but apply to all the programs you can and remember to update your LOR to be dated may or June 2020

 

[ChessMaster3000]

Sorry for your struggles. Looking at your application, it seems to be fairly decent. 2 first author publications, assuming they are full manuscripts (but are they?) is respectable. By no means a stand out application, but still competitive to some degree. As such, I am surprised you only got 5 interviews. I have several thoughts on your situation:

1. I disagree heavily with your PD that your CS initial fail was the reason you had limited interviews. Your Step 1 score at 227 is in my view more likely to have screened you out, and a CK in the 240s isn't too impressive as most people get higher scores on CK than Step 1. Step 3 score irrelevant. Thus, I would hesitate to focus on "explaining" your CS on your next round of interviews - it draws attention to a negative, and you are making a big assumption that programs are viewing your CS fail as a major negative and that assumption, if you decide to focus on it, could cost you. I would wager that the majority of programs do NOT care about this. Further, trying to explain it that you were sick that day is complete BS, even if it was true. Anyone who failed the CS the first time, would say the very same thing, that they were sick. I don't think it is unreasonable for your PD to put a single line in their LOR about the CS, but not more than that.

2. You mention your LORs as follows: "2 GI LOR from nationally known faculty who works at the university, the last GI letter was also from a well published faculty at my home institution"
-forget about if they are "nationally-known" and "well-published". do they know YOU well? were you tempted by having a big name write your letter more than someone who has worked with you clinically? it is VERY difficult to have 3 GI letters all from people who know you clinically, since most of your iM residency occurs OUTSIDE of a GI rotation. Consider getting another LOR, even if it is non-GI, from someone you worked with very closely on a medicine rotation, and who thinks you are truly an excellent clinician. Just getting LOR from people who you did projects with is 100% insufficient. don't be afraid of a non-GI letter. I had one from an ID doc, and I think it was probably my strongest letter because he/she could comment more on my clinical work than any of my GI letters.

4. 2 posters - one of which you presented at DDW. what about the other one? where was that accepted? what kind of conference was it? if you have any posters that are not 1st author, leave them off your application

5. As for what do next year - I would say hep fellowship OR hospitalist year. Do NOT do a GIM fellowship. fellowships are not used to get into other fellowships with the sole exception of hepatology fellowship. can you imagine trying to explain yourself on the GI interview trail next year...."so, you're doing a GIM fellowship which is formal training in a career in the field of academic internal medicine, yet it's only been a few months into the fellowship and you're already trying to get into a different field? why should we trust that you won't be trying to get out of our fellowship right after you start" "oh, I was only doing the GIM fellowship so that I could get into GI" "oh...."

 

[1Cor1557]

Hi guys,

I unfortunately did not match this year and just want to get your insights on all the things I can do to improve my chances.

AMG
Step 1: 227 Step 2 CK: 240s Step 2 CS passed at second attempt (I was sick the first time) step 3: Cannot remember the score now. Maybe 220s-230s.
Chief resident.
No in-house fellowship. From a community program with connection to a highly ranked university programs.
4 GI publications (2 as first author and 1 as second). 1 published in hepatology.
1 Abstract that won an award at ACG though I did not present it myself but was listed as first author, 1 Case report in ACG
2 posters (I presented 1 at DDW).
4 LORs (strong PD LOR since I am chief, 2 GI LOR from nationally known faculty who works at the university, the last GI letter was also from a well published faculty at my home institution)

I applied first to 40 programs and added about 80 more 2 weeks after the application opens. Overall I got only 5 interviews. I talked to my PD and some GI attendings afterwards and they think it was because of my CS attempt that got me screened out (though another recent poster has 11 IV with a failed CS so it could just be my app) and hurt my final ranking. My PD has personal connection with one of the GI PD nearby (where I did interview and have very good feedback afterwards) and is trying to find out exactly why I did not match there so I am waiting to hear from that. My PD said I should have proactively explained about the CS during interview trails and she could have put in her letter to support it.

My affiliated university program offered a 1 year GIM fellowship that is supposed to give additional training to internist on sub-specialty topics (I can do away rotation on GI to build some connection), med ed, Ultrasound and time for clinical research and QI.

I can't change the CS and my mediocre board score but here are the things I am planning to do differently next cycle:
1) Apply broadly from the very beginning.
2) Address the CS fail in LOR and interview.
3) Be more aggressive in having faculty calling for me.
4) Take the above GIM fellowship to stay in academic and wrap up my outstanding research projects. Also I think it looks better than just doing hospitalist and if I do end up never match and want to to academic hospitalist it will help.

However, from my reading on here seems like the best chance is to do hepatology year. The programs I found are below, if you know of any other place especially on the West Coast please let me know. Thank you.

Temple
Rutgers
UMissouri
Virginia Mason
Dartmouth
UChicago
Einstein (Philly)

Do what shishi and chess said
Tlr
do #1 & 3
Dont do #2&4 above

 

[FattySlug]

sorry to hear that.

your plan is excellent. Do the Hep fellowship. Keep on publishing or work as a Hospitalist on a GI group.

but apply to all the programs you can and remember to update your LOR to be dated may or June 2020

Thank you. I am looking into the deadlines for all the hep programs and see which ones are possible to apply to.
Do you think a GIM fellowship is a bad idea? I thought it sounds better than doing hospitalist.

Sorry for your struggles. Looking at your application, it seems to be fairly decent. 2 first author publications, assuming they are full manuscripts (but are they?) is respectable. By no means a stand out application, but still competitive to some degree. As such, I am surprised you only got 5 interviews. I have several thoughts on your situation:

1. I disagree heavily with your PD that your CS initial fail was the reason you had limited interviews. Your Step 1 score at 227 is in my view more likely to have screened you out, and a CK in the 240s isn't too impressive as most people get higher scores on CK than Step 1. Step 3 score irrelevant. Thus, I would hesitate to focus on "explaining" your CS on your next round of interviews - it draws attention to a negative, and you are making a big assumption that programs are viewing your CS fail as a major negative and that assumption, if you decide to focus on it, could cost you. I would wager that the majority of programs do NOT care about this. Further, trying to explain it that you were sick that day is complete BS, even if it was true. Anyone who failed the CS the first time, would say the very same thing, that they were sick. I don't think it is unreasonable for your PD to put a single line in their LOR about the CS, but not more than that.

2. You mention your LORs as follows: "2 GI LOR from nationally known faculty who works at the university, the last GI letter was also from a well published faculty at my home institution"
-forget about if they are "nationally-known" and "well-published". do they know YOU well? were you tempted by having a big name write your letter more than someone who has worked with you clinically? it is VERY difficult to have 3 GI letters all from people who know you clinically, since most of your iM residency occurs OUTSIDE of a GI rotation. Consider getting another LOR, even if it is non-GI, from someone you worked with very closely on a medicine rotation, and who thinks you are truly an excellent clinician. Just getting LOR from people who you did projects with is 100% insufficient. don't be afraid of a non-GI letter. I had one from an ID doc, and I think it was probably my strongest letter because he/she could comment more on my clinical work than any of my GI letters.

4. 2 posters - one of which you presented at DDW. what about the other one? where was that accepted? what kind of conference was it? if you have any posters that are not 1st author, leave them off your application

5. As for what do next year - I would say hep fellowship OR hospitalist year. Do NOT do a GIM fellowship. fellowships are not used to get into other fellowships with the sole exception of hepatology fellowship. can you imagine trying to explain yourself on the GI interview trail next year...."so, you're doing a GIM fellowship which is formal training in a career in the field of academic internal medicine, yet it's only been a few months into the fellowship and you're already trying to get into a different field? why should we trust that you won't be trying to get out of our fellowship right after you start" "oh, I was only doing the GIM fellowship so that I could get into GI" "oh...."

Thank you for your reply. Yes the two first author papers are full manuscripts. One is a review article and the other is an original study.

1. You may be totally right about my whole situation with the USMLE. That was exactly how I felt about the situation while applying so I did not bring it up at any interviews. After I failed to match my PD, chair of medicine and 1 GI attending told me they thought the CS was the reason so I did not know what to think.

2. The big name GI attending knows me well. I did not just ask him because he is well known. I agreed with all of your points and after reviewing things I don't think my LORs are an issue.

3. The other poster on a GI topic was only accepted at ACP and I was first author.

4. I really do not mean to use it purely as a way to get in GI since I agree with you that the two have nothing to do with one another. I was genuinely thinking if I never get GI I still want to do academic hospitalist and this year might be me a tiny edge. I thought at worst this GIM fellowship will look like a wash and not a negative in my apps. Also, looking at this particular GIM fellowship structure, it gives me a lot of flexibility to do research, scheduling interviews and possible to do a GI consult rotation at a different nearby institution where I can potentially build some relationships.

 

[ChessMaster3000]

any chance you get a third first author manuscript accepted in the next 6 months??

1. I continue to disagree with them about that issue, unless your PD’s GI contact/friend can verify that. Random GI attending and chief of medicine still are not qualified to say whether CS did or did not cause you to fail. They are not the people in the fellowship program making the decisions. Plus, How did you present your question to your chair of medicine and that rando GI attendjng? Did you say, I think my CS fail screwed me, do you agree yes/no? the way they are asked this question directly relates to how they respond to it.

4. Come on, we are talking about academic Hospitalist..... It is NOT a competitive field. You do not need an “edge”. your "edge" is the fact that you were an academic internal medicine chief. don't try to sell yourself that you need another year of sub par pay just to get an edge - you DONT. If you do (make the mistake of) GIM fellowship, then you need to decide NOW if you want to commit to that field lifelong. If you do Hospitalist year, then you can still have time to do GI versus stick w aca Hospitalist. You will get better experience and get paid more as a hospitalist. So really your decision is: if I want to try for GI for sure, 1) hep fellowship 2) research fellowship or 3) hospitalist, not necessarily saying that's the best order for it.

Lastly, if you do want to try for GI again, you need to double down on your affiliated local GI fellowship. meet with the PD there before the application cycle, or do a rotation there while youre still a chief. kind of "shoot the moon" on that fellowship. that's what I would do. youre a chief NOW use that time to your advantage, instead of trying to justify a wasted year of gIM fellowship just because it "provides elective opportunities". Anyway, now would be the time do it, before July of next year when you’d apply, not some time in the middle of next year when it’s already too late

 

[FattySlug]

any chance you get a third first author manuscript accepted in the next 6 months??

1. I continue to disagree with them about that issue, unless your PD’s GI contact/friend can verify that. Random GI attending and chief of medicine still are not qualified to say whether CS did or did not cause you to fail. They are not the people in the fellowship program making the decisions. Plus, How did you present your question to your chair of medicine and that rando GI attendjng? Did you say, I think my CS fail screwed me, do you agree yes/no? the way they are asked this question directly relates to how they respond to it.

4. Come on, we are talking about academic Hospitalist..... It is NOT a competitive field. You do not need an “edge”. your "edge" is the fact that you were an academic internal medicine chief. don't try to sell yourself that you need another year of sub par pay just to get an edge - you DONT. If you do (make the mistake of) GIM fellowship, then you need to decide NOW if you want to commit to that field lifelong. If you do Hospitalist year, then you can still have time to do GI versus stick w aca Hospitalist. You will get better experience and get paid more as a hospitalist. So really your decision is: if I want to try for GI for sure, 1) hep fellowship 2) research fellowship or 3) hospitalist, not necessarily saying that's the best order for it.

Lastly, if you do want to try for GI again, you need to double down on your affiliated local GI fellowship. meet with the PD there before the application cycle, or do a rotation there while youre still a chief. kind of "shoot the moon" on that fellowship. that's what I would do. youre a chief NOW use that time to your advantage, instead of trying to justify a wasted year of gIM fellowship just because it "provides elective opportunities". Anyway, now would be the time do it, before July of next year when you’d apply, not some time in the middle of next year when it’s already too late

I am working on third first author manuscript. Ideally I am aiming for two.
1. I just told them what my app weaknesses are among other things and they seem to think the CS fail the reason. Like I mention earlier my PD has personal connection with the fellowship director and she said she will try to find out exactly what happened. I am waiting on that.
4. I don't think I can do any outside rotation from now until June because of my chief duties.